4Incident Reporting QAOP 700-002 Incident Reporting Procedures Timelines for submission
5PurposeEstablishes procedures and guidelines for identifying and reporting information related to incidents that may be defined as major or critical.
6PurposeA major or critical incident shall be any unplanned event resulting in or having the distinct potential of seriously or negatively impacting the program participant, staff, volunteer, a visitor, or center facility in the following areas:HealthSafetyWelfarePublic trust or media coverage of a certified center
7ScopeThis operating procedure applies to all incident reporting and risk prevention in certified domestic violence centers under contract with FCADV.Please note: It is the responsibility of all certified domestic violence center staff paid or unpaid to promptly report all incidents in accordance with the requirements of these procedures.
8ScopeThis reporting procedure does not replace the abuse, neglect and exploitation reporting system as required by Chapter 39 and 415, F.S.Regardless of the determination based on the guidelines any allegations of abuse, neglect or exploitation shall always be reported immediately to the Florida Abuse Hotline on the statewide toll-free telephone number ( ABUSE).
10AltercationAny incident resulting in a serious injury that requires medical treatment by a licensed health care professional due to a physical altercation between two or more participants, or their dependents; or between one or more participant, their dependent, an employee, or a volunteer.
11Sexual BatteryAny incident resulting in a participant alleging sexual battery by another participant, employee, or volunteer while residing at the shelter facility or while receiving outreach services.
12Serious Injury/Illness Any incident resulting in a serious injury or illness that requires the response of law enforcement, emergency medical services, paramedics, or firefighters and is a result of conditions at the center that pose a serious risk of imminent harm to the health or safety of participants.
13EmbezzlementTheft/larceny of center assets (money or property) by any staff member or volunteer. (Seek the advise of your CPA)
15What is immediate notification? Any incident which the center is required to report to the Executive Director and FCADV within 5 hours by telephone.Please note: Regardless of the perceived severity of the issue, all incidents of death, communicable disease or negative media coverage should be reported to FCADV immediately by telephone.
16What’s next?During normal business hours telephone reporting to FCADV shall be made by contacting the FCADV Contract Administrator or Contract Manager at the main phone line (850) Incident reporting after normal business hours may be made to the Quality Assurance Department at (850) or to the President/CEO at (850)
17Timelines for Submissions All incidents requiring immediate notification by telephone shall be followed-up with the completion of the incident reporting form within 24 hours of the incident to the FCADV Contract Manager.
18Closure of Facility, Outreach Office or Hotline Failure Any act in which the facility must close or there is hotline failure of five hours duration or longer. FCADV may assist with the coordination of relocation for residents and the transfer of hotline calls to another center.
19Communicable DiseaseAny outbreak of a communicable disease in the shelter facility that requires implementation of control procedures or a quarantine order issued by the State Health Officer or county health department.
20OtherAny action by a program participant, their dependent, an employee, or a volunteer, that results in an adverse/negative inquiry by public media, the Legislature, or the Office of the Governor.
21DeathAny incident that involves the death of participant or their dependent which occurs while residing at the shelter facility or while receiving outreach services, or any incident that involves the death of an employee or a volunteer while working or on center property.
23Example 1You witness Participant X13 slap participant YZ56 in the face. You immediately step in to keep this incident from escalating. Law enforcement is called and participant X13 is arrested. Participant YZ56 is upset but states she will be okay. Is this reportable?
25Example 2Approximately 12 noon participant 123xyz’s abuser approached the gate of the shelter, rang the bell, and asked for the participant by name. He was immediately instructed to leave the premises by staff. The Sheriffs office was contacted and located him down the street from the shelter. Upon asking him a few question he becomes belligerent and gets arrested.
27Example 3Participant 123X’s completes her safety plan and has decided it’s time to relocate and find a place of her own. She moves two counties away to start a new life with her child. After 3 years of doing very well and living on her own, your center is notified that participant 123X’s body was found at her residence. Is this reportable?
28Reportable- If the file is open Answer 3Reportable- If the file is openDeath - Any incident that involves the death of participant or their dependent which occurs while residing at the shelter facility or while receiving outreach services, or any incident that involves the death of an employee or a volunteer while working or on center property.
30Incident Reporting Forms There are two incident reporting forms:Domestic Violence Center General Incident Report formDomestic Violence Center Death Incident Report formCenters may use these forms as part of their own internal incident reporting policy and procedure, even if the incident does not rise to the level of requiring a report to FCADV.
31Incident Reporting Forms The Domestic Violence Center Incident Report Form and the Domestic Violence Center Death Incident Report form shall be filled out by the staff person having witnessed the incident or having first hand knowledge of the issue. Hand written documentation and documentation that is not 100% perfect English is completely acceptable. Clarification or more detailed information can always be obtained later if necessary.
32Reporting ProceduresFor incidents that involve participants or their dependents, the actual names shall not be included in the report, only participant case numbers shall be used for identification.Incident reporting forms shall be completed fully and provide a detailed summary of the incident including specifics as to who, what, where, how and when.
33Reporting ProceduresIncident reports are to be submitted to FCADV utilizing the following address:
36Programmatic Closeout Includes, but is not limited to, determining and documenting that:All deliverables (i.e. primary prevention, rural, ARRA, etc. and reports were received and approved in writingProgram objectives were metRemedies have been assessed for non-performance/non-compliance
37Fiscal Closeout Cont.Disallowed costs and unused grant funds have been recoveredFinal payment to provider is made only after all programmatic and fiscal steps have been completedAll financial reports has been reviewed and approved in writingExpenditure review has been performedMatch requirements have been met
38Fiscal Closeout Unexpended Funds All funds disbursed under contract with FCADV shall be fully expended on costs authorized by and in accordance with, the terms of the contract. Within 90 days following the end of FCADV’s fiscal year of this contract, the provider shall return any unexpended funds to FCADV.
39FY Contract OverviewNew contracts will be ed to centers by the tentative date of June 15thAn executed copy must be submitted to FCADV by June 30thAll contracts shall be fully executed by July 1stOnce the contract has been fully executed a copy shall be mailed to centersPost Award Notices will be sent 60 days after execution
42Budget AmendmentsThe deadline to submit final budget amendments is March 31, 2010.Budget amendment forms are accessible on the FCADV website using the following link:Submit all budget amendments to the following address:
444th Quarter Reporting Requirements During the 4th quarter of this fiscal year centers are required to submit the Exhibit F (Monthly Financial Report) along with a profit and loss (P&L) statement generated from the center’s accounting system. The Exhibit F, accompanied with the P&L statements, must be submitted to FCADV with each invoice.Note: Centers on a cost reimbursement contract are not required to submit the Exhibit F form however the P&L report is required.
45Quarterly Deliverables Board meeting minutesQuarterly Financial ReportMust be accompanied by Profit & Loss financial report generated from the accounting system (FCADV Funding Only)Prior quarters can not be adjusted
46ADA Compliance (Support to the Deaf or Hard of Hearing)
47OverviewAs a directive from the Department of Children and Families, and to ensure all centers comply with requirements/guidelines of the CDA 10-10, this directive was released in response to the Department of Children and Families (DCF) entering into a Settlement Agreement with the U.S. Department of Health and Human Services, Office of Civil Rights (OCR), Region IV. The focus of this directive is to provide grant and contract provisions pertaining to accommodating the special needs of the deaf or hard -of-hearing. The provisions shall apply to grant recipients and contracted providers, as well as their partners, subcontractors, and agents, who provide direct client services and employ 15 or more employees.
48Time Sensitive Requirements The provider shall, if the provider or any of its partners, subcontractors, or agents employs 15 or more employees, designate a Single-Point-of-Contact (one per firm) to ensure effective communication with deaf or hard-of-hearing customers or companions in accordance with Section 504 and the ADA. The name and contact information for the provider’s Single-Point-of-Contact shall be furnished to the FCADV Contract Manager within 14 calendar days of the effective date of this requirement.
49Time Sensitive Requirements The provider’s Single-Point-of-Contact will ensure that conspicuous Notices which provide information about the availability of appropriate auxiliary aids and services at no-cost to the deaf or hard-of-hearing customers or companions are posted near where people enter or are admitted within the agent locations. Such Notices must be posted immediately, but not later than March 12, 2010, with respect to current providers (partners, subcontractors, and agents). The approved Notice can be downloaded through the Internet at:
50Time Sensitive Requirements The provider shall, within 30 days of the effective date of this requirement, contractually require that its partners, subcontractors and agents comply with section 504 and the ADA. A Single-Point-of-Contact shall be required for each partner, subcontractor or agent that employs 15 or more employees. This Single-Point-of-Contact will ensure effective communication with deaf or hard-of-hearing customers or companions in accordance with Section 504 and the ADA and coordinate activities and reports with the provider’s Single-Point-of-Contact.
51Time Sensitive Requirements The provider and its partners, subcontractors, and agents shall document the customer’s or companion’s preferred method of communication and any requested auxiliary aids/services provided in the customer’s record. Documentation, with supporting justification, must also be made if any request was not honored. The provider shall submit Compliance Reports monthly, not later than the 15th day of each month, to the FCADV Contract Manager. The provider shall distribute Customer Feedback forms to customers or companions, and provide assistance in completing the forms as requested by the customer or companion.Please Note: A start date has not been established for submitting the compliance monthly reports. The Department of Children and Families will notify FCADV when this activity is to start. FCADV in turn will notify each center.Kim Wiley, Domestic Violence and Disability Trainer
52FCADV Upcoming Trainings Contracts and Quality Assurance Unit
53FCADV Contracts & Standards Training When: May 18-19, 2010Where: Swan & Dolphin Hotel – Orlando, FLTime: 9:00 – 4:00 pm DailyRegistration Fees: NoneScholarships are available on a first come, first service basisPlease register TODAY!
54Adjournment 425 Office Plaza Dr. Tallahassee, FL 32301 (850)425-2749 If at anytime you have questions or concerns please contact us directly using the following:FCADV425 Office Plaza Dr.Tallahassee, FL 32301(850)